Who should we vaccinate?

What should happen if we have a deadly flu epidemic? How do we prioritize who should receive the vaccine? This article discusses the ethical issues in a very interesting way. – Elderly Should Be Last for Pandemic Vaccine, Ethicists Argue

The sick and elderly should be last in line for scarce flu vaccine in a pandemic—rather than near the front of the queue—according to two bioethicists associated with the National Institutes of Health.

“I’m not trying to anger the elderly, but the fact of the matter is if we have a disaster we may have to ration,” said NIH clinical bioethics Ezekiel Emanuel, M.D., Ph.D., in an interview. That being so, he added, there must be decisions on priorities.

Both in terms of ethics and prudent public health planning for a flu pandemic, current plans in the U.S. and Canada have missed the boat, Dr. Emanuel and bioethicist Alan Wertheimer, Ph.D., argued in the May 12 issue of Science.

“This (paper) is not meant to be anti-anybody,” Dr. Emanuel said. “It’s meant to ask the questions what’s fair and what’s prudent in terms of public health.”

There’s no dispute about who should head the list. Current plans say that health care workers and people involved in vaccine production get the first doses if a pandemic begins and the bioethicists agree that’s the right choice.

But current plans also give higher priority to the elderly, sick, and infants. This is based on the long-standing principle that those most at risk of dying should get the first crack at treatments.

But next in line after health-care and vaccine workers, the bioethicists argued, should be healthy people between the ages of 13 and 40, followed by people on the fringes of that group—those ages seven to 12 and 41 to 50.

Who should we protect? How should we triage? While these issues are currently theoretic, they could become reality. These bioethicists have examined the issue from a societal perspective. They make explicit a difference in the value of individual lives to society.

We generally try to avoid such thoughts and discussions. However, I believe in this possible scenario, we must explicitly have exactly the discussions the bioethicists have championed.